A Narrative Review of Revascularization in Chronic Coronary Syndrome/Disease: Concepts and Misconceptions.

Ischemic heart disease represents a significant global burden of morbidity and mortality. While revascularization strategies are well defined in acute settings, there are uncertainties regarding chronic coronary artery disease treatment. Recent trials have raised doubts about the necessity of revascularization for "stable", chronic coronary syndromes or disease, leading to a shift towards a more conservative approach. However, the issue remains far from settled. In this narrative review, we offer a summary of the most pertinent evidence regarding revascularization for chronic coronary disease, while reflecting on less-often-discussed details of major clinical trials. The cumulative evidence available indicates that there can be a prognostic benefit from revascularization in chronic coronary syndrome patients, provided there is significant ischemia, as demonstrated by either imaging or coronary physiology. Trials that have effectively met this criterion consistently demonstrate a reduction in rates of spontaneous myocardial infarction, which holds both prognostic and clinical significance. The prognostic benefit of revascularization in patients with heart failure with reduced ejection fraction remains especially problematic, with a single contemporary trial favouring surgical revascularization. The very recent publication of a trial focused on revascularizing non-flow-limiting "vulnerable" plaques adds further complexity to the field. The ongoing debates surrounding revascularization in chronic coronary syndromes emphasize the importance of personalized strategies. Revascularization, added to the foundational pillar of medical therapy, should be considered, taking into account symptoms, patient preferences, coronary anatomy and physiology, ischemia tests and intra-coronary imaging.

Coronary Artery Calcium Identified on Non-Gated Chest CT Scans: A Wasted Opportunity for Preventive Cardiological Care.

BACKGROUND: Coronary artery calcium (CAC) evaluated on dedicated cardiac computed tomography (CT) is an independent predictor of cardiovascular events. This study aimed to evaluate the correlation between CAC detected on non-gated standard chest CT and coronary lesions on coronary angiography (CAG) and determine its impact on prognosis. METHODS: Consecutive patients who underwent CAG due to acute coronary syndrome and had prior non-contrasted non-gated chest CT were included and retrospectively evaluated. Coronary artery calcium was evaluated by quantitative (Agatston score) and qualitative (visual assessment) assessment. RESULTS: A total of 114 patients were included in this study. The mean time difference between chest CT and CAG was 23 months. Coronary artery calcium was visually classified as mild, moderate, and severe in 31%, 33%, and 16% of patients, respectively. Moderate or severe CAC was an independent predictor of significant lesions on CAG (OR 22; 95% CI 8-61; p<0.001) and all-cause mortality (OR 4; 95% CI 2-9; p=0.001). Quantitative CAC evaluation accurately predicted significant lesions on CAG (AUC 0.81; p<0.001). While significant CAC was identified in 80% of chest CTs, formal reporting was 25%. CONCLUSION: Coronary artery calcium evaluation with chest CT was feasible and strongly associated with severity of coronary disease on CAG and mortality. Although the identification of CAC on chest CT represents a unique opportunity for cardiovascular risk stratification for preventive care, CAC underreporting is frequent.

Indirect consequences of coronavirus disease 2019: Skin lesions caused by the frequent hand sanitation and use of personal protective equipment and strategies for their prevention.

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enforced the use of hand sanitation and of personal protective equipment, such as masks and visors, especially by health-care professionals, but also by the general public. However, frequent hand sanitation and the prolonged and continuous use of personal protective equipment are responsible for constant frictional and pressure forces on skin causing lesions, the most reported being acne, facial itching, dryness, and rash. Thus, it is important to find measures to prevent skin lesions, in order to improve the quality of life of health-care professionals and of the general public. This article gathers the current information regarding measures to prevent human to human transmission of COVID-19, reviews the most common skin lesions caused by the use of hand sanitizers and different types of personal protective equipment, and the possible preventive measures that can be used on a daily basis to minimize the risk of developing skin-related pathologies. Daily skin care routines and the incorporation of a dressing between the skin and the personal protective equipment to serve as a protective barrier are some of the applied measures. Moisturizers and dressings improve the skin's ability to respond to constant aggressions. Lastly, the need for additional studies to evaluate the lubrication properties of different types of dressings is discussed. The understanding of what kind of dressing is more suitable to prevent pressure injuries is crucial to promote healthy skin and wellbeing during pandemic times.

Nanomaterials in hair care and treatment.

Hair care and treatment has evolved significantly through the years as new formulations are continuously being explored in an attempt to meet the demand in cosmetic and medicinal fields. While standard hair care procedures include hair washing, aimed at hair cleansing and maintenance, as well as hair dyeing and bleaching formulations for hair embellishment, modern hair treatments are mainly focused on circumventing hair loss conditions, strengthening hair follicle properties and treat hair infestations. In this regard, active compounds (ACs) included in hair cosmetic formulations include a vast array of hair cleansing and hair dye molecules, and typical hair treatments include anti-hair loss ACs (e.g. minoxidil and finasteride) and anti-lice ACs (e.g. permethrin). However, several challenges still persist, as conventional AC formulations exhibit sub-optimal performance and some may present toxicity issues, calling for an improved design of formulations regarding both efficacy and safety. More recently, nano-based strategies encompassing nanomaterials have emerged as promising tailored approaches to improve the performance of ACs incorporated into hair cosmetics and treatment formulations. The interest in using these nanomaterials is based on account of their ability to: (1) increase stability, safety and biocompatibility of ACs; (2) maximize hair affinity, contact and retention, acting as versatile biointerfaces; (3) enable the controlled release of ACs in both hair and scalp, serving as prolonged AC reservoirs; besides offering (4) hair follicle targeting features attending to the possibility of surface tunability. This review covers the breakthrough of nanomaterials for hair cosmetics and hair treatment, focusing on organic nanomaterials (polymer-based and lipid-based nanoparticles) and inorganic nanomaterials (nanosheets, nanotubes and inorganic nanoparticles), as well as their applications, highlighting their potential as innovative multifunctional nanomaterials towards maximized hair care and treatment. STATEMENT OF SIGNIFICANCE: This manuscript is focused on reviewing the nanotechnological strategies investigated for hair care and treatment so far. While conventional formulations exhibit sub-optimal performance and some may present toxicity issues, the selection of improved and suitable nanodelivery systems is of utmost relevance to ensure a proper active ingredient release in both hair and scalp, maximize hair affinity, contact and retention, and provide hair follicle targeting features, warranting stability, efficacy and safety. This innovative manuscript highlights the advantages of nanotechnology-based approaches, particularly as tunable and versatile biointerfaces, and their applications as innovative multifunctional nanomaterials towards maximized hair care and treatment.

A mathematical modeling strategy to predict the spreading behavior on skin of sustainable alternatives to personal care emollients.

Spreadability is one of the most important physicochemical properties of cosmetic products, according to the consumer. Thus, it is fundamental to develop strategies with the aim to improve the knowledge and predict the behavior of alternatives to synthetic emollients. The main goal of this research article was to correlate different physicochemical attributes, namely spreading value, apparent viscosity, density, saponification value, iodine value, peroxide value, acid value and melting range, with the spreading behavior of sustainable alternatives for petrolatum and dimethicone. The sensitivity and adequacy of each parameter were statistically analyzed, and the models were built by forward selection. The two adjusted and optimized models include viscosity and density as parameters and, in the petrolatum case, the model further includes the melting range, which was also validated as a significant predictor. Furthermore, it was also possible to compare the data obtained with the consumer's perception of the spreading behavior of the studied raw materials. A strong correlation was observed, suggesting that these tools mirror the consumer opinion. The application of these mathematical models is a valuable tool to assist the entire replacement process, which usually is a time-consuming procedure.

Investigations of Olive Oil Industry By-Products Extracts with Potential Skin Benefits in Topical Formulations.

The by-products of olive oil industry are a major ecological issue due to their phenolic content, highly toxic organic load, and low pH. However, they can be recovered and reused, since their components have antioxidant, anti-inflammatory, and photoprotector properties. In this work, oil-in-water creams containing three different olive oil industry by-products extracts were produced without the use of organic solvents. First, the extracts were thoroughly characterized in vitro for cytotoxicity, inhibition of skin enzymes, and antioxidant and photoprotection capacities. Safety studies were then performed, including ocular and skin irritation tests, ecotoxicity evaluation, and in vivo Human Repeat Insult Patch Test. The results obtained in this initial characterization supported the incorporation of the extracts in the cream formulations. After preparation, the creams were characterized for their organoleptic, physicochemical, droplet size and rheological properties, and microbial contamination. The results showed that all formulations were semi-solid creams, with stable pH, compatible with the skin, without microbial contamination, and with the expected droplet size range. The rheological analysis showed shear-thinning behavior with yield stress, with the viscosity decreasing with increasing shear rate. The oscillatory results suggest that the creams have a strong network structure, being easily rubbed into the skin. Finally, compatibility, acceptability and antioxidant efficacy were evaluated in vivo, in human volunteers. No adverse reactions were observed after application of the formulations on skin and the cream with the highest concentrations of phenolic compounds showed the highest antioxidant efficiency. In conclusion, the results suggest that olive oil industry by-products extracts have valuable properties that favor their re-use in the cosmetic industry. The example presented here showed their successful incorporation into creams and their impact in these formulations' appearance, pH, and rheological performance, as well as their in vivo compatibility with skin and antioxidant efficiency.

Replacing Synthetic Ingredients by Sustainable Natural Alternatives: A Case Study Using Topical O/W Emulsions.

With the increasing debate on sustainability, there is a strong market trend to formulate more sustainable products for topical application. Several studies emphasize the potential applications of natural, organic, or green chemistry-derived ingredients, but comparative studies between conventional ingredients and sustainable alternatives are lacking. This type of study is considered an excellent baseline and time-saving strategy for future studies. In addition, one of the main challenges of replacing ingredients by sustainable alternatives in topical vehicles is to maintain high-quality products. Thus, the main goal of this research study was to create a well-defined strategy supported by specific experimental data for the development of sustainable topical vehicles with high-quality standards. The study was designed to evaluate the effects of replacing conventional ingredients (e.g., hydrocarbons, silicones, and preservatives) by sustainable ones on the physical, chemical, and microbiological features of topical emulsions. Additionally, in vivo assessment studies were performed to evaluate the safety, biological efficacy, and sensorial aspects of the developed formulations. The results obtained showed that the replacement of ingredients by sustainable alternatives has an effective impact on the physicochemical and structural properties of the emulsions, mainly on their rheological behavior. However, using appropriate strategies for ingredient selection and rheological adjustment, it is possible to overcome some barriers created by the use of natural raw materials, thus developing appealing and high-quality sustainable topical vehicles.

[Correlation between anesthetic decision and clinical characteristics and results in patients submitted to TAVI]. / Correlação entre decisão anestésica e as características clínicas e resultados em doentes submetidos a TAVI.

OBJECTIVE: The preoperative factors determining the selection of anesthetic technique in patients submitted to TAVI were identified. The results of this procedure in our hospital were evaluated. METHODS: Retrospective study in patients submitted to TAVI in Santa Marta Hospital (January 2010 to December 2016). Data collected from periprocedural records and stratified according to the anesthetic technique. Periprocedural complications were defined according to The Valve Academic Research Consortium 2. The preoperative factors determining the selection of anesthetic technique were identified through Chi-square test (categorical variables) and Student's t tests (continuous variables), followed by logistic regression. RESULTS: Bad vascular access identified by TC was a preoperative determinant for general anesthesia selection. Arterial hypertension and previous acute myocardial infarction were determinants for selection of local anesthesia with sedation. From a total of 149 patients, 105 (70,5%) developed some postprocedural complication; the most common were arrhythmias (n=53; 35,6%), major bleeding (n=50; 33,6%) and vascular complications (n=36; 24,2%). CONCLUSION: There is no consensus regarding the best anesthetic technique to be performed in patients submitted to TAVI. It is the anesthesiologist decision which most appropriate anesthetic technique to select, considering technical aspects and objective evaluation of the patient. Local anesthesia with sedation showed some advantages: shorter duration of procedure and fewer patients requiring vasopressor drugs administration. TAVI is a highly complex procedure and a multidisciplinary approach is fundamental to its success.

Objetivo: Foram identificados fatores pré-operatórios relacionados com o doente, determinantes para seleção da técnica anestésica em doentes submetidos a TAVI, e avaliados os resultados deste tipo de intervenção no nosso centro. Métodos: Estudo retrospetivo em doentes submetidos a TAVI no Hospital de Santa Marta (Janeiro de 2010 a Dezembro de 2016). Dados colhidos a partir dos registos peri- procedimento, e estratificados de acordo com a técnica anestésica. As complicações periprocedimento foram definidas de acordo com The Valve Academic Research Consortium-2. Os fatores pré-operatórios determinantes para a seleção da técnica anestésica foram identificados com os testes Qui-quadrado (variáveis categóricas) e t de Student (variáveis contínuas), e posterior regressão logística. Resultados: Os maus acessos vasculares definidos por TAC foram o fator pré-operatório determinante para a seleção de anestesia geral. A hipertensão arterial e a ocorrência de enfarte agudo do miocárdio prévio foram determinantes da escolha da anestesia local com sedação. Dos 149 doentes, 105 (70,5%) desenvolveram alguma complicação pós-operatória, sendo as mais comuns as arritmias cardíacas (n=53; 35,6%), perdas sanguíneas major (n=50; 33,6%) e as complicações vasculares (n=36; 24,2%). Conclusão: Não existindo consenso quanto à melhor técnica anestésica a realizar para a TAVI, cabe ao anestesiologista a seleção da técnica mais adequada, tendo em conta aspectos técnicos e a avaliação objetiva do doente. A anestesia local com sedação mostra alguns benefícios: menor duração do procedimento e um menor número de doentes a requerer a administração de fármacos vasopressores. A TAVI apresenta elevada complexidade, sendo a abordagem multidisciplinar fundamental para o seu sucesso.

Community intervention: assessment of parental training of a family prevention programme of substance use and associated risk behaviours / Intervención comunitaria: evaluación de la formación de los padres de un programa de prevención familiar de consumo de sustancias y comportamientos de riesgo asociados

Abstract The manuscript presents the results of a family and community intervention project to prevent drug use. The project was theoretically based in two integrative models - Structural Model of Cowen and Eco-Developmental Model - taking a multicausal perspective and the methodological principle of empowerment. This study had two assessment moments: (T1) a week before the intervention and (T2) a week after the end of the intervention. Data was collected from 42 adults with parenting responsibilities and the results indicate significant changes in the increase of cohesion, expressivity, control, and the increase of the orientation for recreational activities. It has also observed a decrease of the educational strategies that characterise the authoritarian and permissive styles.

Resumen El manuscrito presenta los resultados de un proyecto familiar de intervención comunitaria de prevención del consumo de drogas. El proyecto se basa en dos modelos de integración: modelo estructural de Cowen y modelo ecodesarrollo, adoptando una perspectiva multicausal y guiándose por el principio metodológico de empoderamiento. Este estudio tuvo dos momentos de evaluación: (T1) una semana antes de la intervención y (T2) una semana después del final de la intervención. Se presentan los datos reunidos de 42 adultos con responsabilidades parentales y los resultados indican cambios significativos en el ámbito familiar en el aumento de la cohesión, expresividad, el control y de la orientación de las actividades recreativas. También se observa una disminución de las estrategias educativas que caracterizan los estilos autoritarios y permisivos.

Lumbar Cerebrospinal Fluid Drainage in Endovascular Aortic Repair - Reference Centre Experience.

INTRODUCTION: Spinal cord ischemia (SCI) and the resulting paraplegia are one of the most feared postoperative complications after thoraco-abdominal aortic surgery, with an incidence 4,3-8,0% after thoracic endovascular aortic repair (TEVAR), increasing patients morbi-mortality. Lumbar cerebrospinal fluid (CSF) drainage catheter is recommended as preventive measure in high risk patients. OBJECTIVE: To evaluate the efficiency and safety of CSF drainage catheter as preventive or therapeutic measure in endovascular aortic repair (EAR). METHODS: Retrospective study in 19 patients submitted to TEVAR or fEVAR (fenestrated endovascular aneurism repair), in whom CSF drainage catheter was used, between January 2010 and March 2017. Collected data regarding demographic, perioperative patients characteristics, neurologic symptoms (NS) and other complications. All patients were submitted to general anesthesia (GA) as result of complexity and length of surgery. Known risk factors (RF) for SCI were taken into account. RESULTS: 19 patients, 89,5% (n=17) male, mean age of 66±9 years. 63,2% were classified as ASA III and 36,8% as ASA IV. 9 patients submitted to TEVAR (47,4%); the remaining were submitted to fEVAR. 73,7 % were programed procedures. There were intraoperative complications in 3 patients: iliac artery (IA) rupture in 2 patients, laceration of the axillary artery in 1 patient, all required surgical repair. All catheters were placed in awake patients, before GA induction, and were left in place 2,5 days. 7 patients needed drainage because of CSF pressure>10mmHg intra- or postoperatively. 3 patients developed early symptoms of SCI (decreased mobility and strength of legs). Complete recovery occurred in all patients, except one who recovered just partially. 1 patient developed late NS: paraparesia on 40th postoperative day (POD) as result of spinal stroke. 30 days mortality was 10,5% (n=2), due to cardiorespiratory arrest- 1 by hypovolemic shock (on 3rd POD), 1 by unknown cause (14th POD). CONCLUSION: This study was limited by the small sample size. CSF drainage catheter was an efficient measure in prevention and treatment of SCI in this sample, since there was no case of complications due to SCI. CSF drainage seems to be an effective technique in preventing SCI. Further studies are required to determine the effectiveness and compare the different methods available for the prevention of SCI complications.

P-glycoprotein activity in human Caucasian male lymphocytes does not follow its increased expression during aging.

P-glycoprotein (P-gp) is a transmembrane protein that mediates the efflux of innumerous structurally unrelated compounds. It was initially found over-expressed in tumor cells, associated to a multidrug resistance phenotype (MDR). Then, P-gp was found constitutively expressed in excretory cells/tissues and in circulating cells, such as lymphocytes. Considering the importance of this transporter in the establishment of therapeutic protocols and the existence of contradictory results, this study aimed at evaluating the influence of aging in the expression and function of P-gp in human lymphocytes, comparing two different methodologies to assess both parameters. P-gp activity and expression were evaluated in lymphocytes isolated from whole blood samples of 65 healthy caucasian male donors, divided into two groups according to age (group 1: under 30-years old; group 2: above 60-years old). P-gp expression was assessed using the anti-P-gp monoclonal antibody, UIC2, in the presence and in absence of vinblastine (Vbl). P-gp activity was evaluated measuring the efflux rate of the fluorescent P-gp substrate rhodamine 123 (Rho 123) and also using UIC2 shift assay. Flow cytometric analysis was performed to assess all the proceedings. Furthermore, P-gp expression and each of the P-gp activity determination methods were compared, through correlation analysis and linear regression models. We observed a significant age-dependent increase in mean P-gp expression (p = 0.029), which was not reflected in the transporter's activity (p > 0.050). Statistical analysis allowed selection of UIC2 shift assay over Rho 123 efflux assay as a more selective method to assess P-gp activity. Despite the significant correlation between P-gp expression and P-gp activity found in lymphocytes (Gp1(group 1)-r = 0.609, p < 0.001; Gp2-r = 0.461, p = 0.012), using UIC2 shift assay, these data reinforce the need for P-gp activity assessment, rather than P-gp expression determination alone, when starting new therapeutic regimens with P-gp substrates, especially in men older than 60 years of age.

Comparison of sampling techniques for parallel analysis of transcript and metabolite levels in Saccharomyces cerevisiae.

Mathematical modelling of cellular processes is crucial for the understanding of the cell or organism as a whole. Genome-wide observations, at the levels of the transcriptome, proteome and metabolome, provide a high coverage of the molecular constituents of the system in study. Time-course experiments are important for gaining insight into a system's dynamics and are needed for mathematical modelling. In time-course experiments it is crucial to use efficient and fast sampling techniques. We evaluated several techniques to sample and process yeast cultures for parallel analysis of the transcriptome and metabolome. The evaluation was made by measuring the quality of the RNA obtained with UV-spectroscopy, capillary electrophoresis and microarray hybridization. The protocol developed involves rapid collection by spraying the sample into -40 degrees C tricine-buffered methanol (as previously described for yeast metabolome analysis), followed by the separation of cells from the culture medium in low-temperature rapid centrifugation. Removal of the residual methanol is carried out by freeze-drying the pellet at -35 degrees C. RNA and metabolites can then be extracted from the same freeze-dried sample obtained with this procedure.

WITHDRAWN: Comment on "The strong correlation between alkalaine phosphatase activity and Q1 cell viability"

The Publisher regrets that this article is an accidental duplication of an article that has already been published in YCBIR, doi:10.1016/j.cellbi.2007.07.001. The duplicate article has therefore been withdrawn.